JP2012518488A - Probe for carpal tunnel opening or tissue dissection - Google Patents

Abstract

It is a probe for a surgical instrument used for incising a selected tissue in a cavity while performing a visual inspection, for example, a surgical instrument used for opening a transverse carpal ligament body. The flat upper surface of the probe has a larger width dimension than the lower surface. The lower surface has a side surface or a curved surface inclined inward. At any location on the lower surface below the flat upper surface, the width of the lower surface in the direction connecting the first edge and the second edge of the upper surface is smaller than the width between the edges at any location on the upper surface. Depending on the degree of inwardly inclined side or curved surface, when the probe is inserted, the tissue is moved downward (not upward), generating an upward force to the tissue to be incised. And generates a downward force on the tissue surrounding the probe on the lower side of the probe.
[Selection] Figure 1a

Description

    The present invention relates to a probe for carpal tunnel opening or tissue dissection.

  MicroAir Surgical Instruments is based on US Pat. No. 4,962,770 by Agee et al., US Pat. No. 4,963,147 by Agee et al., US Pat. No. 4,963,147 by Agee et al. Surgical tools have been sold for many years based on US Pat. No. 5,089,000 and US Pat. No. 5,306,284 by Asie et al. The disclosure of that patent is hereby incorporated by reference in its entirety. A recent improvement of the handpiece designed by Assy is described in US Pat. No. 7,628,798 by Welborn, the disclosure of which is hereby incorporated by reference in its entirety. To do. This surgical tool is used to examine and manipulate selected tissue within a body cavity and is particularly used to perform a safe and effective carpal tunnel opening procedure. These surgical tools include handle assemblies, probe members, optical systems, and cutting systems. The optical system and the cutting system allow a surgical knife blade to be selectively inserted into and removed from a side opening formed in the upper surface portion of the probe tip through the handle to the probe.

  The desired use of surgical instruments in performing carpal free surgery is accomplished by making a short transverse incision proximal to the carpal canal and wrist flexure. After incision to extend in the longitudinal direction, the incision extends through the deep fascia of the forearm to the distal extension leading to the flexor brachia to avoid damage to the sensory nerve. After incising the finger flexor synovium, wrist extension exposes the proximal opening of the carpal tunnel, thereby forming a pathway to the carpal tunnel. In a tool designed by Assy, the direction of rotation of the probe relative to the handle or holder can be adjusted to meet the surgeon's requirements. After adjusting the direction of rotation of the probe, the probe is inserted through the incision, preferably through the length of the carpal and to the distal end of the transverse carpal ligament.

  By using the optical system, the tissue in the carpal canal is clearly visualized on the display of the video monitor connected to the illumination source and video camera associated with the optical system, via manipulation of the patient's limbs. It becomes. It is desirable that the probe tip facilitates probe insertion by gently moving the tendon, sac, and median nerve in the carpal tunnel. The side opening of the probe is arranged at a position close to the surface of the flexor retinaculum, and the shape of the upper surface of the probe (preferably a flat surface) is a region around the side opening of the moved tissue. It is desirable to exclude from. The marker is used to indicate the point on the probe where the scalpel blade is raised to facilitate proper placement of the probe relative to the distal end of the flexor strut.

  The surgeon deploys the cutting blade through the display to abut the distal end of the flexor strut at the appropriate location while viewing the tissue to be dissected. The tip of the blade is preferably deployed to a position sufficient to completely cut the ligament. By pulling out the probe while looking at the desired path of the developed cutting blade (through the side opening formed in the probe), the flexor retinaculum is separated and the carpal tunnel is released.

U.S. Pat. No. 4,962,770 U.S. Pat. No. 4,963,147 US Patent No. 5,089,000 US Pat. No. 5,306,284 US Pat. No. 7,628,798

  The surgical tool described by Azi et al. Is safe and effective and has a good reputation in the surgeon community. It is further desirable to improve the design of the probe to increase safety during the cutting action.

  A probe for a surgical instrument used to dissect selected tissue in a cavity while performing visual inspection, such as a surgical instrument used to open a transverse carpal ligament, for example, is an implementation of the present invention. In this embodiment, it has a flat upper surface and a semicircular lower surface adjacent thereto.

  Further, a probe for a surgical instrument used for incising a selected tissue in a cavity while performing visual inspection, such as a surgical instrument used for opening a carpal transverse ligament body, is provided by the present invention. In an embodiment, it has a flat upper surface and a lower surface adjacent thereto, the lower surface has side surfaces that slope inward, each side surface extending from a respective edge of the flat upper surface, Inclined 5 degrees or more, 10 degrees or more, 20 degrees or more, or 30 degrees or more inward from the vertical line passing through each edge of the upper surface.

  According to the present invention, the probe is triangular or trapezoidal (or other polygonal shape) or semi-circular (half a circle and the arc is 180 degrees), and any probe on the lower surface below the flat upper surface. The width of the portion is smaller than the width of the top surface, thereby providing a number of safety advantages. For example, the tilted side or semicircular side can lock tissue away from the blade incision path, reducing the amount of probe movement, reducing nerve apraxia, and helping generate in vivo reaction forces. Thus, the incision probe is held against the transverse carpal ligament.

The probe of the present invention is for a surgical instrument used for incising a selected tissue in a body cavity while performing visual inspection, and is particularly used for releasing a carpal transverse ligament body. The probe has a proximal end that is connected to or connectable to a surgical handpiece. That is, in some cases, the probe is separated from the handpiece and is disposable. On the other hand, in other cases, the probe may remain connected to the handpiece. For example, the handpiece and the probe are both disposable. The proximal end is open as much as possible for the passage in the probe of the optical system and cutting instrument extension system. A hollow portion extends from the proximal end to the closed probe tip. The hollow portion has a flat upper surface in which an opening is formed in the vicinity of the tip portion. (I.e., the opening is preferably closer to the tip than the proximal end and within a few millimeters or centimeters of the tip). An incision instrument while viewing tissue at the opening using an optical system. The extension system is operated to cause the cutting blade to protrude from and retract into the opening. The flat top surface has a first edge and a second edge, and the distance between the first edge and the second edge defines the width of the top surface. The magnitude of this width is constant or varies slightly over the length of the probe. (The width of the upper surface on the proximal end side is larger than the width of the upper surface on the tip end side.)
The lower surface is connected to the first edge and the second edge of the flat upper surface. The dimensions and shape of the lower surface are defined so that the optical system and the cutting instrument extension system can pass through the space between the flat upper surface and the lower surface. The lower surface has a semicircular side surface in cross section, or a plurality of inclined side surfaces (for example, the cross section forms a triangle, trapezoid, or other polygon). In the case of having a plurality of inclined side surfaces, these side surfaces are inclined inward by 5 degrees or more from the respective vertical lines passing through the first edge and the second edge, and below the flat upper surface. At any location on the lower surface on the side, the width of the lower surface in the direction connecting the edges of the upper surface is smaller than the width between any edges of the upper surface.

  A first advantage of such a shape is that the side surface is inclined toward the bottom while the upper surface of the probe is kept horizontal, and the tissue in the carpal tunnel is moved downward to be separated from the blade. When incising the transverse carpal ligament, it is not uncommon for tissues such as the median nerve and tendon to slide on the upper surface of the probe into the blade path. It is not desirable to cut the median nerve or tendon. Having inwardly sloping or curved sides moves the tissue further down when the probe is inserted into place without entering the blade path. This improves safety and increases the effectiveness of surgery.

  Another advantage of the probe is that the overall capacity of the probe can be reduced while maintaining the desired width of the top surface, for example 15 mm. The upper surface of the probe has several important roles such as the safety and effectiveness of transcarpal ligament opening. For example, the instrument can be applied directly to the back side of the transverse carpal ligament with a flat top surface. This location leaves no room for the tissue to enter the field of view and excludes it from the blade path. Furthermore, the width of the flat top surface must be such that the rejected tissue can be maintained at a distance from the blade. The shape of the probe intended in the present invention can retain the advantages of a flat top surface and at the same time reduce the probe capacity. This feature of providing safety is important to avoid nerve compression syndrome. By reducing the drainage capacity of the probe, the shape of the probe reduces the chance of neural apraxia.

  Another advantage of the probe is that it has an inwardly sloping or curved side so that reaction forces within the carpal canal can be used, and the incising probe is transcarpal ligament (or other incision) Is held against the organization). An inwardly sloping or curved side provides the advantage of creating a vertical reaction force. This reaction force presses the probe against the transverse carpal ligament (or other tissue to be incised). Thus, tissue is removed from the blade path, improving the safety and effectiveness of the operation.

The figure which shows the probe of the triangle or trapezoid shape by embodiment of this invention. The figure which shows the conventional probe which is not provided with an inclined surface. The figure seen from the bottom face direction which arranged the triangular or trapezoidal probe by embodiment, and the conventional probe which does not have an inclined surface with the same dimension as this probe. The figure seen from the upper surface direction which arranged the triangle or trapezoid probe by embodiment, and the conventional probe which does not have an inclined surface with the same dimension as this probe. The figure which shows the semicircle-shaped probe by embodiment of this invention.

    The present invention provides an improved probe for a surgical instrument used to dissect selected tissue within a body cavity while performing visual inspection, and is disclosed in U.S. Pat. No. 7,628,798, and a surgical instrument used for opening a carpal transverse ligament body, and the contents of these publications should be included in this specification. In particular, the present invention relates to the shape of the probe and specifically contemplates a probe shape in which the width of the flat upper surface of the probe is greater than the width of the lower surface of the probe. That is, the side surface forming the lower surface is inwardly inclined or curved, and the width between the side surfaces in the direction connecting the edges of the upper surface at any location on the lower surface of the flat upper surface is It is smaller than the width between the edges. The degree of side inclination is such that the tissue can be shut out from the cutting path of the blade. A probe having a side surface or a curved surface whose lower surface is inclined inward can reduce the amount of movement of the probe and reduce nerve apraxia. In addition, the lower surface facilitates the generation of the reaction force in the living body and holds the incision probe against the lateral carpal ligament.

  FIG. 1a is a diagram showing an end of a probe 10 according to an embodiment of the present invention, and the probe 10 has a triangular or trapezoidal shape.

  FIG. 1 b is a view showing an end portion of a conventional probe 100, and the probe 100 has a substantially square shape.

  Each of the probes 10 and 100 has a flat upper surface 12 and 102, and the width dimension W of the upper surface is the same. Preferably, the width W is in the range of 0.1 cm to 5 cm. The flat top surface 12, 102 keeps the probe 10, 100 flat against the tissue to be incised. Also, the width W separates the incision blade 14 or 104 from the tissue site that should not be incised.

  The shapes of the probe 10 and the probe 100 are greatly different from each other when the lower surfaces 16 and 106 are different from each other. According to FIG. 1a, the probe shape is triangular or trapezoidal, whereas in FIG. In the embodiment shown in FIG. 1a, the lower surface 16 has inclined side surfaces 18,20. The inclined side surfaces 18 and 20 extend from the first edge 22 and the second edge 24, respectively, of the flat top surface 12, and as indicated by the angles A and A ', the first edge 22 and the second edge, respectively. It is inclined 5 degrees or more, 10 degrees or more, 20 degrees or more, or 30 degrees or more inward with respect to the vertical line passing through the portion 24. Due to the shape of the probe 10, the width of the lower surface in the direction connecting the first edge portion 22 and the second edge portion 24 of the upper surface at any location on the lower surface 16 below the flat upper surface 12 is any edge of the upper surface. It is smaller than the width between parts. As a result, the probe 10 presses the tissue surrounding the probe 10 downward, and when in the predetermined position, the surrounding tissue presses the probe 10 upward. Thus, the flat upper surface 12 is firmly held in the tissue to be incised, and the blade 14 in which other tissue (eg, tendons, sac, nerves, etc. present in the carpal tunnel) slides over the probe and is incised. Can be prevented from entering the path.

  On the other hand, in the substantially rectangular probe 100 as shown in FIG. 1B, the surrounding tissue does not press downward against the surrounding tissue, and the surrounding tissue acts on the probe 100 with an upward pressing force. Not. Depending on the degree of molding, the width of the upper surface 102 may be larger than that between the side walls of the lower surface 106 for the substantially rectangular probe 100 (for example, when the inclination of the side wall is 2 degrees or less). However, when the inclination is slight, the safety improvement feature due to the shape of the present invention is not sufficient. This is because the inclination is not sufficient for the downward and outward movement of the surrounding tissue, and the inclination is not sufficient for the surrounding tissue to exert an upward reaction force on the probe.

  Further, the shape of the probe 10 can greatly reduce the volume compared to the conventional probe. This can reduce the damage to the compression system.

  2 and 3 show probes 10 and 100 of the same size side by side, and are used as a surgical instrument for releasing the transverse carpal ligament. In general, probe 10 is similar in most respects to probe 100 and may be a replacement for current instruments used to open carpal tunnels such as those available from Micro Air Surgical Instruments, Charlottesville, VA. Is. That is, the probe 10 is made of resin, but may be made of a composite material of glass and metal. The probe 10 is hollow and has a proximal end 28 that remains connected or connectable to the surgical handpiece. The proximal end 28 is open and passes through an optical system (not shown) and a cutting instrument extension system. The probe 10 has a hollow portion 30 that extends to a closed tip 32, the length of which varies, particularly in the range of 3 cm to 15 cm. An opening 34 is formed on the flat upper surface 12 of the probe 10 on the side close to the tip 32. Through the opening 34, the cutting blade 14 can selectively protrude from or retract into the probe, and the optical system can be passed through the probe 10 to image tissue above the opening 34. In this manner, the surgeon moves the probe 10 within the body cavity while performing a visual inspection, and then selectively disposes the cutting blade 14 from the opening 34 to provide the desired tissue (eg, lateral carpal ligament). Make an incision.

  The probe shown in FIG. 1a has a triangular or trapezoidal shape, but may have other polygonal shapes as long as the lower surface is inside the upper surface with respect to any part of the edge of the upper surface.

  FIG. 4 shows a modification based on this technical idea, and the probe 50 has a semicircular shape. That is, the circumferential angle of the lower surface 52 is 180 degrees, and an arc extends from the left edge 54 and the right edge 56 of the upper surface 58. Because the lower surface 52 is semicircular, there is an immediate slope from the edges 54, 56 compared to the lower side 106 of the conventional probe 100 shown in FIG. 1b. With this configuration, the flat upper surface 58 is stably held by the tissue to be incised, and other tissues existing in the carpal tunnel, such as tendons, sac, and nerves, slide on the probe 50 to cut the incising blade 14. Can be prevented from entering the path.

  Although the present invention has been described with reference to the above-described embodiments, it should be readily understood by those skilled in the art that various modifications can be made within the scope of the present invention.

10, 50 Probe 12, 58 Upper surface 14 Blade 16, 52 Lower surface 18, 20 Side surface 22, 54 First edge 24, 56 Second edge 28 Proximal end 30 Hollow portion 32 Tip 34 Opening

Claims (8)

A probe for a surgical instrument used to dissect selected tissue in a body cavity while performing visual inspection,
A proximal end connected to or connectable to the surgical handpiece, a tip, and a hollow;
The proximal end is open as much as possible for the passage of the optical system and the cutting instrument extension system;
The tip is closed,
The hollow portion extends from the proximal end to the tip and has a flat upper and lower surface;
The upper surface is formed with an opening in the vicinity of the distal end, and the cutting tool extension system is operated while visually inspecting the tissue at the opening using the optical system so that the cutting blade protrudes from the opening. Retreat to
The flat top surface has a first edge and a second edge, and the distance between the first edge and the second edge defines the width of the top surface;
The lower surface is connected to the first edge and the second edge of the flat upper surface so that the optical system and the cutting instrument extension system can pass through the space between the flat upper surface and the lower surface. Dimensions and shapes are defined,
The lower surface has a semicircular side surface or a plurality of inclined side surfaces, the side surfaces extending from the first edge and the second edge, and the first edge and the second edge. The width of the lower surface in the direction connecting the edges of the upper surface is inclined at an angle of 5 degrees or more inward with respect to each vertical line passing through the portion at any location on the lower surface below the flat upper surface. A probe characterized by being smaller than the width between any edges on the top surface.   The probe according to claim 1, wherein the lower surface of the hollow portion has a semicircular cross-sectional shape.   The probe according to claim 1, wherein the lower surface of the hollow portion has a triangular or trapezoidal cross-sectional shape.   The lower surface of the hollow portion has a sloped side surface, and the side surface extends from the first edge portion and the second edge portion, and more than each vertical line passing through the first edge portion and the second edge portion. The probe according to claim 1, wherein the probe is inclined inward by 10 degrees or more.   The lower surface of the hollow portion has a sloped side surface, and the side surface extends from the first edge portion and the second edge portion, and more than each vertical line passing through the first edge portion and the second edge portion. The probe according to claim 1, wherein the probe is inclined inward by 20 degrees or more.   The probe according to claim 1, wherein the probe is made of a resin.   The probe according to claim 1, wherein the hollow portion has a length in the longitudinal direction of 3 cm to 15 cm.   The probe according to claim 1, wherein the flat upper surface has a width in a range of 0.1 cm to 1.5 cm.

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